Tobacco Control has morphed into a crusade intent on demonizing both tobacco users and the industry supplying them. This blog examines and comments on scientific issues surrounding tobacco policies - and fallacies.

Monday, December 22, 2014

The Monitoring the Future
survey shows that past 30-day cigarette use among 12th graders dropped from
16.3% in 2013, to 13.6% in 2014, the largest single-year decline in the
survey's 39-year history (data here).

The data show that 17% of
12th graders had used e-cigarettes in the past 30 days in 2014, the first year
this information was collected.

Good news included a decline
in the percentages of high school seniors reporting alcohol use, being drunk
and marijuana use in the past 30 days.

Instead of focusing on the
historic drop in smoking, the media emphasized that more students had used
e-cigarettes than traditional cigarettes.However, Tim Worstall, a Fellow at the Adam Smith Institute in London, saw
things differently, writing, “That vaping, at least so far as we know, is the
most successful smoking cessation product any one has as yet invented (and do
note that nothing else at all has halved teen [daily] smoking rates in only 5
years) means that we really shouldn’t be putting roadblocks in front of further
adoption of the technology.” (here)

Smoking prevalence among high
school seniors has declined every year since 2007, about the time that
e-cigarettes were introduced in the U.S.With numbers like this, claims that e-cigarettes cause children to smoke
are completely unfounded.In fact, the
evidence is strongly suggestive that e-cigarettes have played a role in this
unprecedented decline in teen smoking.

Tuesday, December 16, 2014

If reading’s not your thing, you can now get the facts on
smokeless tobacco and tobacco harm reduction via two new offerings – the
audiobook version of my updated text, “For Smokers Only” (here)
and a lively YouTube conversation on the issues with Darcy Compton, president of
Mudjug (click on the video).

I started advocating for smokers to switch to vastly safer
smokeless tobacco products some 20 years ago, when my research showed that
health risks related to smokeless use were but a tiny fraction of those associated
with smoking.

My first journal articles caused an uproar.A National Cancer Institute director called
me “unethical” for suggesting that smokers switch, and I was attacked by
outraged national dental associations and colleagues (here).Their message was plain: do your
research, but don’t tell smokers what I had discovered – that the claimed
health risks of smokeless tobacco were largely fabricated, and the resulting
misinformation was preventing smokers from considering a quitting option that
worked. (My findings have since been widely duplicated and accepted.)

I resolved to devote my career to educating smokers about safer
smoke-free products, and in 1995 I authored a book, “For Smokers Only: How
Smokeless Tobacco Can Save Your Life.”

Last year, my publisher released the ebook version, updated
with a fresh chapter on e-cigarettes.It’s available at Amazon (here), Barnes and Noble (here) and ITunes (here).Now he’s issued the audiobook version,
downloadable at Audible.com (here).

Darcy Compton, California manufacturer of Mudjug portable
spittoons (here),
has developed a global online following.His YouTube review of “For Smokers Only” has attracted some 225,000 visitors
(here).Darcy and I recently sat down for a
lengthy conversation on all aspects of smokeless tobacco use.

I am indebted to Darcy and Mudjug for their vocal support of
my scientific findings and groundbreaking work in tobacco harm reduction.

Monday, December 8, 2014

The New York Times has added more fuel to the
anti-tobacco-harm-reduction fire with a December 4 editorial (here) rehashing the somewhat slanted reporting that appeared in the paper’s news
pages on November 30. In two stories
that day, the Times explored issues surrounding Swedish Match’s FDA application
to change the warnings on its snus products.As I noted (here), “The Times and their quoted experts did a major disservice to their
audience; they failed to report the simple truth, that mouth cancer risk for
Swedish snus is next to nil.”

The original warning labels that Congress ordered
for tobacco product packages in 1986 were factually wrong and fatally
misleading to smokers, chewers and dippers.Congress didn’t make the warnings more accurate whenit ordered the FDA to regulate tobacco in
2009, it just made them cover more of the package – an action it didn’t take with
cigarettes.

The Times editorial acknowledged that snus is “is
less harmful than smoking tobacco,” but it painted Swedish Match’s application
as a marketing ploy.That ignores the
critical need to terminate government’s lie about products’ health risks.

The editors echoed tobacco prohibitionists in
denying that snus played a role in the Swedish experience.Said the Times, “reduced smoking rates and
lower rates of tobacco-related diseases such as lung and oral cancer” in Sweden
since the 1970s “is debatable,” attributing the successes to “various bans,
restrictions and public health campaigns.”The editors failed to consider that the reductions are exclusively seen
in men – who use snus and have the lowest lung cancer rate in Europe – not in
women, who rank fifth in Europe for lung cancer.

The Times acknowledged that their reporters had “cited
independent experts who found that snus is not nearly as lethal as cigarettes,”
but it added the qualifier “[snus] is not risk-free either, especially for
users who also smoke.”It is patently
obvious that smoking is risky for anyone, including snus users.It should also be obvious that a smokeless
tobacco can labeled “this product is not a safe alternative to cigarettes” encourages
smokers to stick with their habit.

The Times editors revisit the discredited gateway theory
(“the danger is that snus might lead some nonsmokers and former smokers to…progress
on to cigarette smoking”), but they ignore substantial evidence that this has
not happened in Sweden (here) or in the U.S. (here).

Summing up, the Times observes: “abstention would be
the safest approach.”That might work in
Neverland, but in the U.S., abstention was impossible for the 8 million smokers
who died in the 20 years since I first described our government’s warnings as
bogus.That is no one’s definition of
safe.

Wednesday, December 3, 2014

The New York Times has published (here) a reasonably accurate portrayal of the Swedish snus experience that I have chronicled
for over a decade (here,
here,
and here).Reporters Matt Richtel and David
Jolly examined Swedish Match’s FDA application to remove the federally mandated
mouth cancer and not-safe-alternative warnings from snus products. I have
discussed this landmark filing previously (here).

In a companion piece (here) the paper tried to answer two important questions about snus and mouth cancer:
“How accurate is the current warning? How dangerous is Swedish snus?”

Despite a wealth of available information, the Times unfortunately
failed to nail the answers, even after acknowledging that “Many
studies have been done on the question (sic),..." but fretting that "...but as in many fields that
involve complex questions and human subjects, the research is imperfect.”

How is the research imperfect?“For instance, some research concluding
virtually no oral cancer risk from snus was funded by Swedish Match itself.” The Times fell back on the old canard – the
funder influenced the finding, despite total disclosure and high-quality peer
review.The paper failed to note that numerous
studies, regardless of funding, show “virtually no oral cancer risk” for
Swedish snus and American chew and dip.

The Times asked Kristin L. Sainani, a Stanford
epidemiologist not involved in tobacco research, to examine the science.She was remarkably indecisive: “‘The weight
of the evidence suggests a small increase’ in the risk of oral cancer with
snus.In Sweden, users of Swedish snus
see virtually no increase in the rates of lip and oral cancer.”In the end
she made the correct call: virtually no increase.

Dr. Sainani attempted to provide an anti-snus slant using double negatives: she said that “it is inconsistent with the evidence” to suggest that there is “absolutely no harm to an individual” from snus. In essence, she repeated the no-win argument
that snus can’t be proven absolutely safe.That’s an irrational standard that many common foods couldn’t meet.

Dr. Sainani was asked by the Times to resolve the mouth
cancer question, yet she is quoted on an entirely different matter: “In fact,
she said, Swedish snus users face a doubling of risk of pancreatic cancer…”It appears that Dr. Sainani exclusively used
a 2008 review by Boffetta et al., which has been exposed as relying on cherry
picked data (here).

Is a snus pancreas cancer risk real?No.Five
years ago I detailed how Boffetta fabricated the risk in 2008 (here), and, in 2011, Boffetta acknowledged that his earlier finding was wrong (here).Sainani would have discovered this if
she had compared the faulty Boffetta analysis with the most authoritative and
comprehensive meta-analysis by Peter Lee and Jan Hamling (here), which found no pancreas cancer risk, in addition to no mouth cancer risk.

The Times article ended with Dr. Deborah Winn, deputy
director of the division of cancer control at the National Cancer
Institute.Readers of this blog know that
Dr. Winn launched the smokeless tobacco mouth cancer scare in 1981 (here and
here).While she is the NCI’s top authority
on smokeless tobacco and cancer, she demonstrated an appalling disregard of
facts in a 2010 congressional hearing (here).In the Times article, her obfuscation
continued:“[Winn] considered Swedish
snus to be ‘a form of smokeless tobacco,’ which, in general, she said, is
generally ‘linked to mouth cancer…Swedish snus in the past has given you
cancer, and at the current low levels, I don’t know,’ she said. ‘There could be
some risk there.’”

The one data point Winn provided to the Times is false.“She said studies done in the 1990s showed
that users of Swedish snus in the 1970s faced a twofold increase in the risk of
oral cancer.”There were two studies of
Swedish snus and mouth cancer published in 1998. They concluded:

1.“[Snus] was not found to be a risk factor for
oral cancer in our study.” (here)

2.“No increased risk [for head and neck cancer,
including oral cancer] was found for the use of Swedish [snus].” (here)

The Times and their quoted
experts did a major disservice to their audience; they failed to report the
simple truth, that mouth cancer risk for Swedish snus is next to nil.

My Credentials

I am a Professor of Medicine at the University of Louisville, I hold an endowed chair in tobacco harm reduction research, and I am a member of the James Graham Brown Cancer Center at U of L.

For the past 20 years I have been involved in research and policy development regarding tobacco harm reduction (THR). THR advocates acknowledge that there are millions of smokers who are unable or unwilling to quit with conventional cessation methods involving tobacco and nicotine abstinence, and we encourage them to use cigarette substitutes that are far safer.

My research has appeared in a broad range of medical and scientific journals. I have authored commentaries in the general press and I wrote the book, For Smokers Only: How Smokeless Tobacco Can Save Your Life. In 2003 I served as an expert witness at a Congressional hearing on tobacco harm reduction, and I have spoken at numerous international forums, including one held in London at the British Houses of Parliament.

My research is supported by unrestricted grants from tobacco manufacturers to the University of Louisville and by the Kentucky Research Challenge Trust Fund.